NEW YORK (Reuters Health) - Patients with pT4 stage gastric
cancer are at increased risk of late recurrence, new research
shows.

About 10% of patients with pT4 disease had recurrence more
than five years after primary resection, Dr. Ju-Hee Lee of
Hanyang University Hospital in Seoul, South Korea, and
colleagues found. "According to our study, tumor depth may be
an important indicator for long-term follow-up," they write.

Most deaths from gastric cancer are due to recurrence,
which usually happens within two years of gastrectomy, the
researchers note. Because recurrence after five years is rare,
they add, close follow-up typically ends at that point. However,
late relapse does occur; one study found a recurrence rate of
10.8% among five-year gastric cancer survivors.

To investigate factors associated with late gastric cancer
recurrence, the researchers looked at 1,573 patients treated
with curative surgery between 1992 and 2006, including 348 who
had recurrence. Twenty-five (7.6%) had recurrence more than five
years after surgery. Median time to recurrence among these
patients was 88.8 months, while 18 had recurrence within eight
years of surgery.

Multivariate analysis found pT classification was the only
independent predictor of late recurrence. The rate of late
recurrence was 0.4% with pT1, 1.7% with pT2-3, and 10.3% with
pT4.

Peritoneal recurrence was the most common type of late
recurrence, occurring in 19 of the 25 patients. This is
different from past studies, the researchers note, which have
found distant metastases to be the most common pattern.

"This may be explained by the relatively low rate of
adjuvant chemotherapy in our study; among 387 patients indicated
for adjuvant chemotherapy according to recent version of
Japanese Gastric Cancer Association treatment guideline, only
282 received and 128 finished >80% of the planned cycle," Dr.
Lee and colleagues write. Also, they note, 13 of the 23 patients
with late recurrences for whom adjuvant chemotherapy was
indicated did not receive treatment or did not finish it.

"Greater attention to peritoneal recurrence may be
recommended in disease-free gastric cancer patients surviving >5
years after gastrectomy who did not receive adjuvant
chemotherapy," the researchers say.

They conclude: "Whether extended follow-up for T4 tumors
affects survival needs to be demonstrated in more large-scale
studies."